Country Policy and Information Note - Afghanistan: Medical treatment and healthcare - GOV.UK
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Country Policy and Information Note Afghanistan: Medical treatment and healthcare Version 2.0 October 2021
Preface
Purpose
This note provides country of origin information (COI) for decision makers handling
cases where a person claims that to remove them from the UK would be a breach of
Articles 3 and/or 8 of the European Convention on Human Rights (ECHR) because
of an ongoing health condition.
It is not intended to be an exhaustive survey of healthcare in Afghanistan.
Country of origin information
The country information in this note has been carefully selected in accordance with
the general principles of COI research as set out in the Common EU [European
Union] Guidelines for Processing Country of Origin Information (COI), April 2008,
and the Austrian Centre for Country of Origin and Asylum Research and
Documentation’s (ACCORD), Researching Country Origin Information – Training
Manual, 2013. Namely, taking into account the COI’s relevance, reliability, accuracy,
balance, currency, transparency and traceability.
The structure and content of the country information section follows a terms of
reference which sets out the general and specific topics relevant to this note.
All information included in the note was published or made publicly available on or
before the ‘cut-off’ date(s) in the country information section. Any event taking place
or report/article published after these date(s) is not included.
All information is publicly accessible or can be made publicly available. Sources and
the information they provide are carefully considered before inclusion. Factors
relevant to the assessment of the reliability of sources and information include:
• the motivation, purpose, knowledge and experience of the source
• how the information was obtained, including specific methodologies used
• the currency and detail of information
• whether the COI is consistent with and/or corroborated by other sources.
Multiple sourcing is used to ensure that the information is accurate and balanced,
which is compared and contrasted where appropriate so that a comprehensive and
up-to-date picture is provided of the issues relevant to this note at the time of
publication.
The inclusion of a source is not, however, an endorsement of it or any view(s)
expressed.
Each piece of information is referenced in a footnote. Full details of all sources cited
and consulted in compiling the note are listed alphabetically in the bibliography.
Feedback
Our goal is to provide accurate, reliable and up-to-date COI and clear guidance. We
welcome feedback on how to improve our products. If you would like to comment on
this note, please email the Country Policy and Information Team.
Page 2 of 21Independent Advisory Group on Country Information
The Independent Advisory Group on Country Information (IAGCI) was set up in
March 2009 by the Independent Chief Inspector of Borders and Immigration to
support him in reviewing the efficiency, effectiveness and consistency of approach of
COI produced by the Home Office.
The IAGCI welcomes feedback on the Home Office’s COI material. It is not the
function of the IAGCI to endorse any Home Office material, procedures or policy.
The IAGCI may be contacted at:
Independent Advisory Group on Country Information
Independent Chief Inspector of Borders and Immigration
5th Floor
Globe House
89 Eccleston Square
London, SW1V 1PN
Email: chiefinspector@icibi.gov.uk
Information about the IAGCI’s work and a list of the documents which have been
reviewed by the IAGCI can be found on the Independent Chief Inspector’s pages of
the gov.uk website.
Page 3 of 21Contents
Assessment .............................................................................................................. 5
Guidance on medical claims ................................................................................... 5
Country Information ................................................................................................ 5
Country information ................................................................................................. 6
1. Basic indicators................................................................................................ 6
2. Healthcare system ........................................................................................... 6
2.1 Governance .............................................................................................. 6
3. Healthcare provision ........................................................................................ 7
3.1 Overview of provision pre-Taliban takeover ............................................. 7
3.2 Provision post-Taliban takeover ............................................................... 8
3.3 Medical supplies ..................................................................................... 11
4. Access to treatment ....................................................................................... 12
4.1 Non-Governmental Organisations (NGOs) ............................................. 12
4.2 Cost of healthcare .................................................................................. 12
4.3 COVID-19 ............................................................................................... 14
4.4 Mental health .......................................................................................... 14
4.5 Physical disabilities ................................................................................ 14
4.6 Women’s health...................................................................................... 15
Terms of Reference ................................................................................................ 17
Bibliography ........................................................................................................... 18
Sources cited ........................................................................................................ 18
Sources consulted but not cited ............................................................................ 20
Version control ....................................................................................................... 21
Page 4 of 21Assessment
Updated: 29 September 2021
Guidance on medical claims
For general guidance on considering cases where a person claims that to remove
them from the UK would be a breach of Article 3 and/or 8 of the European
Convention on Human Rights (ECHR) because of an ongoing health condition, see
the instruction on Human rights claims on medical grounds.
Country Information
Country of origin information on access to and availability of medical treatment is
limited to due lack of available ‘on the ground’ information following the Taliban
takeover in August 2021.
Back to Contents
Page 5 of 21Country information
Section 1 updated: 29 September 2021
1. Basic indicators
Total population (million) 37,466,414 (July 2021 est.)1
Urban population as % of total population 26.3% (2021 est.)2
Life expectancy at birth 53.25 (2021 est.)3
638 deaths per 100,000 live
Maternal mortality rate births (2017 est.)4
106.75per 1,000 live births
Infant mortality rate (2021 est.)5
% of population having access to health 87% (2019 est.)6
services within 2 hours distance by any
means of transport
Back to Contents
Section 2 updated: 29 September 2021
2. Healthcare system
2.1 Governance
2.1.1 Prior to the Taliban takeover, the Afghan Ministry of Public Health managed
projects to build and strengthen primary and secondary health care, which
were funded by the World Bank7. As noted in The Lancet ‘The Sehatmandi
project, which provides for packages of health and hospital services in 31 of
the 34 provinces of the country, is managed by the Ministry of Public Health
through implementing non-governmental organisations in a contracting out
model.’8 On 25 August 2021 it was reported that the World Bank halted its
funding after the Taliban seized control of the country9.
2.1.2 For information on the effect of the funding freeze see Provision post-Taliban
takeover.
2.1.3 On 7 September 2021 the Taliban announced a 33-member government
from its own ranks10 11. Whilst no new acting minister of health was
announced at that time, the Republican-era incumbent minister of public
1 CIA, ‘The World Factbook: Afghanistan’, updated 8 September 2021
2 CIA, ‘The World Factbook: Afghanistan’, updated 8 September 2021
3 CIA, ‘The World Factbook: Afghanistan’, updated 8 September 2021
4 CIA, ‘The World Factbook: Afghanistan’, updated 8 September 2021
5 CIA, ‘The World Factbook: Afghanistan’, updated 8 September 2021
6 WHO, ‘WHO Afghanistan Country Office 2019’ (page 23). 2019
7 The Lancet, ‘The World Bank's health funding in Afghanistan’, 3 September 2021
8 The Lancet, ‘The World Bank's health funding in Afghanistan’, 3 September 2021
9 BBC News, ‘Afghanistan: World Bank halts aid after Taliban takeover’, 25 August 2021
10 AAN, ‘The Focus of the Taleban’s New Government: Internal cohesion…’, 12 September 2021
11 Shaheen, S (@SuhailShaheen1), ‘List of Acting Ministers and Heads…’, 8 September 2021
Page 6 of 21health, Dr Wahid Majruh, was pictured in office, reported the Afghanistan
Analysts Network (AAN) on 12 September 202112.
2.1.4 A report attributed to the New York Times (NYT), dated 2 September 2021,
noted that ‘For the past two weeks, Majrooh [Wahid Majruh] has shared his
office with Mawlawi Abdullah Khan, head of the Taliban’s health commission
whose cooperation he credited with helping coax staff back to work.’ Dr
Majruh stated that 90% of the health ministry’s staff had returned to work13.
2.1.5 Reporting pre-Taliban takeover of control on 15 August 2021, HRW said in a
report dated May 2021, ‘As the Taliban have consolidated control over
approximately half of the districts in Afghanistan, they established a health
policy implemented by provincial and district level health commissions that
oversee all healthcare services, which in almost all cases are provided by
NGOs.’14
2.1.6 In an interview with The New Humanitarian, dated 8 September 2021, Dr
Majruh (Majrooh) said ‘As the days go on, I’m just preparing for a smooth
exit, to hand over most of the issues. The level of coordination between me
and their health commision is good. But the way we work is different. I have
to respect the way they work, because in the longer term, it will be them
leading the [health] ministry.’15 Dr Majruh added that the Taliban ‘… have a
health commission with representatives in every province.’16
2.1.7 Dr Majruh, the last minister from the Republic-era government, was sacked
after new ministerial appointments were made by the Taliban on 21
September 202117. The Taliban appointed Qalandar Ebad as acting Minister
of Public Health, with Mohammad Hassan Ghiasi and Abdulbari Omar as
deputies18 19.
Back to Contents
Section 3 updated: 29 September 2021
3. Healthcare provision
3.1 Overview of provision pre-Taliban takeover
3.1.1 Whilst there were improvements in the public healthcare system post-2001,
it still continued to face challenges due to ‘… damaged infrastructure, a lack
of trained health care providers and under-resourced healthcare facilities,’
which was ‘further complicated by a lack of security and pervasive poverty,’
as reported in an August 2020 report by the European Asylum Support
Office (EASO), which cited several external sources20.
3.1.2 In April 2020, the United States Institute of Peace (USIP) published a
synthesized report of the Afghanistan Analysts Network’s (AAN) district-level
12 AAN, ‘The Focus of the Taleban’s New Government: Internal cohesion…’, 12 September 2021
13 NYT, ‘After quick victory, Taliban find governing is harder’, 2 September 2021
14 HRW, ‘“I Would Like Four Kids – If We Stay Alive” Women’s Access…’ (page 47), May 2021
15 The New Humanitarian, ‘Healthcare, aid, and the Taliban: A Q&A…’, 8 September 2021
16 The New Humanitarian, ‘Healthcare, aid, and the Taliban: A Q&A…’, 8 September 2021
17 Republic World, ‘Afghanistan: Taliban Sacks Last Remaining Minister…’, 22 September 2021
18 Hashte Subh (8am) Daily, ‘The Taliban announce remaining cabinet members’, 21 September 2021
19 SAIR, ‘Weekly Assessments & Briefings Volume 20, No.14’, 27 September 2021
20 EASO, ‘Afghanistan Key socio-economic indicators…’ (page 47), August 2020
Page 7 of 21studies on services in territories controlled or influenced by the Taliban,
which noted: ‘An overarching observation in the AAN reports is that despite
relatively high expenditures on health by developing country standards,
health care across the country is generally poor in both Taliban- and
government-influenced areas. For example, in Afghanistan there are 2.3
physicians and five nurses and midwives per ten thousand people,
compared to global averages of thirteen and twenty, respectively.’21
3.1.3 In April 2020, Human Rights Watch (HRW) reported ‘Hospitals and clinics
are not easily accessible outside of urban areas, and poor access to health
services, especially in rural Afghanistan, is a leading cause of disabilities.’22
3.1.4 HRW reported in May 2020 on women’s access to health care, noting:
‘Taliban officials in Doha, Qatar told Human Rights Watch that there was a
need for more health facilities in rural areas, saying that those that existed
were largely in cities and areas under government control. They urged
NGOs to direct more assistance to rural areas, saying “the needs are dire –
women are dying in childbirth needlessly.” However in November 2020, the
Taliban issued new regulations requiring all NGOs to register with them in
order to provide services in Taliban-held areas. In some areas, Taliban
officials have prevented female staff members of NGOs from traveling in
districts under their control.’23
3.1.5 An article in The Lancet published in June 2020 noted ‘Afghanistan had only
172 hospitals and four doctors per 10 000 people, according to a 2019
government report. Around a third of the 37 million population has no access
to a functional health centre within 2 [hours] of their home, says the UN
Office for the Coordination of Humanitarian Affairs (OCHA).’24
3.1.6 For further background see the archived 2020 Country Policy and
Information Note on Afghanistan Medical and healthcare provision.
Back to Contents
3.2 Provision post-Taliban takeover
3.2.1 On 30 August 2021, Reuters reported that Médecins Sans Frontières (MSF)
and the International Federation of Red Cross and Red Crescent Societies
(IFRC) warned that Afghanistan’s health system was ‘… at risk of collapse…
after foreign donors stopped providing aid following the Taliban takeover.’25
MSF told Reuters, ‘The overall health system in Afghanistan is understaffed,
under-equipped and underfunded, for years. And the great risk is that this
underfunding will continue over time,’ whilst the IFRC said ‘… the healthcare
system, which was already fragile and heavily reliant on foreign aid, had
been left under additional strain,’ noting the ‘massive’ humanitarian needs on
the ground26.
3.2.2 The World Health Organization (WHO) said on 6 September 2021 that
21 USIP, ‘Service delivery in Taliban-influenced areas of Afghanistan’ (page 11), April 2020
22 HRW, ‘“Disability is not a weakness”’ (pages 16 to 17), April 2020
23 HRW, ‘“I Would Like Four Kids – If We Stay Alive” Women’s Access…’ (pages 46 to 47), May 2021
24 The Lancet, ‘Access to health care under threat in Afghanistan’, 27 June 2020
25 Reuters, ‘Afghanistan's healthcare system near collapse, aid agencies warn’, 30 August 2021
26 Reuters, ‘Afghanistan's healthcare system near collapse, aid agencies warn’, 30 August 2021
Page 8 of 21‘A pause in funding for the Sehatmandi project [see paragraph 3.2.3] – the
backbone of Afghanistan’s health system – has left millions of vulnerable
Afghans at risk of losing access to essential health care.
‘The Sehatmandi project is the main source of health care in the country,
provided through more than 20 000 health workers at 2309 health facilities.
In 2020, more than 30 million people benefited from health services provided
through the project, in addition to 1.5 million children vaccinated.
‘A funding pause that went into effect in late August 2021 means that more
than 2000 (90%) of these health facilities are now at risk of closing.’27
3.2.3 The WHO described the Sehatmandi project, noting:
‘Sehatmandi is a multi-donor funded project that provides access to
affordable primary and secondary health care, nutrition and family planning
services across all 34 provinces of Afghanistan.
‘The project is implemented by nongovernmental organizations, which
manage 2309 health facilities that deliver essential package of health
services (EPHS) in hospitals and the basic package of health services
(BPHS) in clinics. The project focuses a) on supporting primary health
centres where services are more likely to be utilized by the marginalized
population; b) on rural areas where poverty levels are high; (c) expanding
the number of primary health centres in provinces that lack of health care
and are poorer compared to others; and (d) supporting completely free
health care through facilities providing BPHS, which reduces financial
barriers to access.’28
See also Cost of healthcare.
3.2.4 The WHO added:
‘With the expected closure of these health facilities, only 3% of the 1318
COVID-19 isolation beds in Afghanistan will remain functional. This hinders
efforts to contain COVID-19 amidst an increased risk of transmission due to
the circulation of the Delta variant, low vaccination coverage and large-scale
population displacement.
‘If not urgently addressed, lost access to health care could lead to thousands
of preventable illnesses and deaths. Women’s access to female health
workers would also be severely affected. To mitigate these impacts, WHO is
working with NGO partners to ensure continuity of services at around 500
prioritized health facilities affected by the funding pause.’29
See also Non-Governmental Organizations (NGOs) and Women’s health.
3.2.5 Gandhara, part of the Radio Free Europe / Radio Liberty group, reported on
16 September 2021 noted that hundreds of healthcare clinics across the
country had closed since the Taliban takeover30. Also reporting on 16
September, Pajhwok News noted ‘Health officials in western Ghor
province… said 91 clinics have been closed due to the non-availability of
27 WHO, ‘Funding pause results in imminent closure of more than 2000 health…’, 6 September 2021
28 WHO, ‘Funding pause results in imminent closure of more than 2000 health…’, 6 September 2021
29 WHO, ‘Funding pause results in imminent closure of more than 2000 health…’, 6 September 2021
30 Gandhara, ‘Aid Groups In Afghanistan Face New Challenges Under…’, 16 September 2021
Page 9 of 21fund[s].’31 A doctor speaking to Gandhara from a hospital in Maidan Wardak
province said they were running out of medicines, facing power shortages,
and were unable to provide food to patients32.
3.2.6 BBC News noted that the estimated number of doctors, nurses and
midwives pre-Taliban takeover (around 4 per 10,00033) was likely to be
lower, given that many had since stopped working or fled the country34.
3.2.7 The News International, Pakistan’s English-language daily, reported on 17
September 2021 on the ‘exodus of medical consultants’ following the Taliban
takeover. According to a consultant haematologist, Dr Ahmed Waleed,
speaking to The News from Kabul, ‘Dozens of local and foreign medical
consultants, who were working at various public and private health facilities
in Kabul and other provinces of the country have fled to US, Canada, Turkey
and other countries following the Taliban takeover. Those still in the country
are extremely demoralized as they have not been paid salaries for last
several months.’35 According to Dr Ahmed, the situation was ‘turning acute in
Kandahar, Jalalabad, Mazar-e-Sharif and Herat.’36
3.2.8 According to reports, female doctors and medical staff were allowed to
continue working, providing they fully covered themselves37 38 39.
3.2.9 On 20 September 2021, BBC News noted there were ‘… reports that
hospitals and clinics are being ordered to allow only female staff to attend to
female patients. One midwife, who wishes to remain anonymous, told the
BBC that a male doctor had been beaten up by the Taliban because he
attended to a woman alone. She says that, at her medical centre in the
country's east, “if a woman cannot be seen by a female doctor, the male
doctor can only see the patient where two or more other people are
present”.’40
See also Women’s health.
3.2.10 On 22 September 2021, Al Jazeera reported that the UN had released $45
million in emergency funds in a bid to stop the Afghan healthcare system
from collapsing, as ‘… medicines, medical supplies and fuel were running
out and that essential healthcare workers were not being paid’, said Martin
Griffiths, the UN’s under-secretary-general for humanitarian affairs and
emergency relief coordinator. The report added, ‘The funds will go to the
UN’s health and children’s agencies, allowing them – with the help of partner
NGOs – to keep hospitals, COVID-19 centres and other health facilities
operating until the end of the year.’41
Back to Contents
31 Pajhwok News, ‘Some Ghor clinics stop functioning after WB halt fund’, 16 September 2021
32 Gandhara, ‘Aid Groups In Afghanistan Face New Challenges Under…’, 16 September 2021
33 The Lancet, ‘Access to health care under threat in Afghanistan’, 27 June 2020
34 BBC News, ‘Giving birth under the Taliban’, 20 September 2021
35 News International, ‘Afghanistan in desperate need of medicines’, 17 September 2021
36 News International, ‘Afghanistan in desperate need of medicines’, 17 September 2021
37 India Today, ‘Taliban ask women doctors, health workers to resume jobs…’, 28 August 2021
38 The Guardian, ‘Afghanistan’s shrinking horizons: “Women feel everything…’, 12 September 2021
39 ITV News, ‘Afghanistan's women journalists, doctors and lawyers reveal...’, 17 September 2021
40 BBC News, ‘Giving birth under the Taliban’, 20 September 2021
41 Al Jazeera, ‘UN releases funds to save Afghan health system from collapse’, 22 September 2021
Page 10 of 213.3 Medical supplies
3.3.1 Reuters noted on 6 September 2021 that the WHO was ‘… liaising with
Qatar for medical deliveries to come by plane’, including COVID tests and
supplies to treat chronic diseases42. The report added that ‘Medical supplies
continue to be flown in via the northern city of Mazar-i-Sharif and the WHO is
also exploring overland options via trucks from Pakistan…’43
3.3.2 On 13 September 2021, the WHO reported on the arrival in Kabul
humanitarian aid consisting of around ‘23 metric tonnes of life-saving
medicines’, with a second due later in the week44. The WHO noted
‘Together, the 2 shipments which contain essential medicines such as
insulin, medical consumables, trauma and surgery kits, and COVID-19
testing kits, will address the urgent health needs of 1.45 million people and
provide for 5400 major and minor surgeries. They will be distributed to 280
health facilities and 31 public COVID-19 laboratories across Afghanistan.’45
3.3.3 Tolo News reported on 18 September 2021 that Afghanistan was dependent
on imported medicines, spending around $400 million dollars a year to
import them from regional countries. The report noted, ‘Officials at the union
of medicine-Importing companies said that around 400 companies are
importing medicine into the country’, but there was only one active laboratory
to test medicine quality. There were reports of a large proportion of low
quality medicine illegally entering the country46.
3.3.4 Reporting on 17 September 2021, The News International were told by a
consultant haematologist, Dr Ahmed Waleed, that ‘… Kabul as well as other
parts of the country were facing an extreme shortage of medicines,
especially life-saving drugs as they were not coming to the country from
Pakistan and India since the change of government as borders were closed
and trade was suspended. “Life-saving medicines, especially those for
chemotherapy and for the treatment of cancers, are not available. If
somebody has any stock, they are being sold at exorbitant prices. People
don't have money to buy the medicines…”.’ 47 The report also noted that Dr
Ahmed said some essential medicines were available, but ‘He maintained
that many other medicines including third-generation antibiotics, drugs for
the treatment of metabolic disorders, neurological conditions, heart ailments,
as well as those for the treatment of diseases of women and children were
also not available, adding that healthcare facilities were unable to treat
patients in these conditions.’48 Regarding the COVID-19 situation, Dr Ahmed
said several private laboratories were performing tests, and ‘… both public
and private hospitals had ample supplies of medical oxygen.’49
42 Reuters, ‘Hundreds of health centres at risk of closure in Afghanistan’, 6 September 2021
43 Reuters, ‘Hundreds of health centres at risk of closure in Afghanistan’, 6 September 2021
44 WHO, ‘Qatar supports shipment of WHO life-saving medical supplies to Kabul’, 13 September 2021
45 WHO, ‘Qatar supports shipment of WHO life-saving medical supplies to Kabul’, 13 September 2021
46 Tolo News, ‘Low Quality Medicine Threatening Lives: Afghan Citizens’, 18 September 2021
47 News International, ‘Afghanistan in desperate need of medicines’, 17 September 2021
48 News International, ‘Afghanistan in desperate need of medicines’, 17 September 2021
49 News International, ‘Afghanistan in desperate need of medicines’, 17 September 2021
Page 11 of 213.3.5 Referring to Mazar-e-Sharif’s main hospital, BBC News reported on 18
September 2021 that ‘… the current reserve stock of medicine will only last
for another month.’50
See also Cost of healthcare.
Back to Contents
Section 4 updated: 29 September 2021
4. Access to treatment
4.1 Non-Governmental Organisations (NGOs)
4.1.1 As the Taliban assumed control of the country, aid agencies continued to
undertake their work. Projects run by Médecins Sans Frontières (MSF)
continued in Herat, Kandahar, Khost, Kunduz, and Lashkar Gah51, focussing
on emergency, paediatric, and maternal healthcare52. The International
Federation of Red Cross and Red Crescent Societies (IFRC) reported on 6
September 2021 that it ‘… continues to be operational through its main
delegation in Kabul, as well as through its field-based offices in Kabul,
Gulbahar, Khost, Ghazni, Kandahar, Lashkargah, Farah, Herat, Maimana,
Mazar-i-Sharif, Kunduz, and Jalalabad.’53 The Swedish Committee for
Afghanistan (SCA) noted its continuing work, having already worked
alongside the Taliban in areas under their control54.
4.1.2 Citing its proposed intervention on health care in an emergency appeal
dated 6 September 2021, the IFRC noted that the Afghan Red Crescent
Society (ARCS):
‘… will need to scale up the provision of health services including by
increasing the number of its mobile health teams. People to be reached will
include but are not limited to community members, IDPs and returnees
residing in the target provinces. Most vulnerable groups like IDPs, returnees,
persons with disabilities, children, women (especially pregnant and lactating
women), malnourished children, elders and those with chronic health
conditions will be prioritized for health assistance. COVID-safe measures will
be integrated.’55
4.1.3 The WHO published a map on 20 September 2021 showing Health Cluster
Partners Operational Presence, as of August 2021, which indicated some
kind of healthcare provision in 120 active locations offered by 22
organisations56.
Back to Contents
4.2 Cost of healthcare
4.2.1 In March 2020, MSF reported that healthcare was not accessible to many
Afghans due to widespread poverty, adding, ‘Patients describe delaying or
50 BBC News, ‘“There’s security but no money”: Afghans settle into life under…’, 18 September 2021
51 MSF, ‘Medical needs urgent as ever in Afghanistan after Taliban takeover’, 18 August 2021
52 MSF, ‘Afghanistan’, no date
53 IFRC, ‘Emergency Appeal’ (page 3), 6 September 2021
54 SCA, ‘SCA’s work continues in Afghanistan’, updated 2 September 2021
55 IFRC, ‘Emergency Appeal’ (page 7), 6 September 2021
56 WHO, ‘Health Cluster Partners Operational Presence (August 2021)’, 20 September 2021
Page 12 of 21avoiding care, or selling essential household goods in order to cover health-
related expenses. While MSF provides health services free of charge, a
growing number of medical facilities in the country have begun collecting
user fees as part of a cost recovery approach, which makes care
unaffordable for many.’57
4.2.2 The UNOCHA noted in its Humanitarian Needs Overview 2021, issued
December 2020, that ‘… 80 per cent of those surveyed by the Asia
Foundation as part of their national perceptions survey in 2020 said the cost
of medications had increased in the past 12 months.’58
4.2.3 Reporting prior to the Taliban takeover, in May 2021 HRW noted the rising
poverty and cost of care, adding, ‘Many women and girls simply cannot
afford health care.’ The report further stated:
‘Even when care is free, or almost free, as in the government hospitals
where the only official fee is a 20 Afs [£0.18] registration fee, the reality is
that, as discussed below, there are often costs to receiving health care that
are difficult or impossible for many to afford. Increasingly, as budgets have
been cut, patients must pay for all medications and supplies used in their
care – something Human Rights Watch found at all government health
facilities we visited. When a patient arrives at a government hospital, for
example a woman in labor, they are typically instructed on what to purchase
and sent out with a prescription to a nearby pharmacy. These supplies
include items like gloves, gauze, catheters, scalpels, sterilizing fluid, and all
medicines.’59
4.2.4 The same source noted:
‘“The patients are providing the medicines and the consumables
themselves,” the director of a government hospital said. “Five years back,
patients would come without even 100 Afs [£0.92]. Now in some big
operations they spend 5,000 Afs [£46] for care – for drugs, consumables.”
The director acknowledged that this was happening at a moment of rising
poverty. “Now the clients don’t have the money. And we also in the hospital
don’t have the money.” He said on five occasions in recent years the hospital
ran out of anti-coagulant drugs and was unable to find them for sale or direct
patients to a place where they could be found. Government health facilities
are also often unable to perform needed diagnostic tests, and instead send
patients to private labs, where they must pay costs that are often around
1,000 to 2,000 Afs (£9 to £18) per test.’60
4.2.5 International funding that subsidised the public health sector was frozen
following the Taliban takeover of Kabul61 62. See Provision post-Taliban
takeover.
Back to Contents
57 MSF, ‘Reality check - Afghanistan's neglected healthcare crisis’, 5 March 2020
58 UNOCHA, ‘Humanitarian Needs Overview 2021’ (page 38), December 2020
59 HRW, ‘“I Would Like Four Kids – If We Stay Alive” Women’s Access…’ (page 30), May 2021
60 HRW, ‘“I Would Like Four Kids – If We Stay Alive” Women’s Access…’ (page 31), May 2021
61 The New Humanitarian, ‘Healthcare, aid, and the Taliban: A Q&A…’, 8 September 2021
62 BBC News, ‘Afghanistan: World Bank halts aid after Taliban takeover’, 25 August 2021
Page 13 of 214.3 COVID-19
4.3.1 For updates on COVID-19, see WHO Updates, UNOCHA Updates and
COVID-19 News and Information | UNAMA.
Back to Contents
4.4 Mental health
4.4.1 An April 2020 report by HRW noted:
‘Mental health services are especially lacking… there are critical gaps in the
availability and quality of psychosocial support and mental health services in
Kabul and other cities, while in rural areas they are virtually nonexistent.
Afghanistan lacks trained personnel in all areas of mental healthcare
provision – psychiatrists, psychiatric nurses, psychologists, and social
workers. The stigma associated socially with psychosocial disabilities
(mental health conditions) is also a significant barrier for people seeking
support.’63
4.4.2 The UNOCHA noted in its December 2020 report that:
‘Four decades of uninterrupted conflict, recurrent natural disasters, endemic
poverty and now the COVID-19 pandemic’s fallout have taken a brutal toll on
the mental health and personal resilience of the people of Afghanistan. While
no comprehensive study has been able to quantify the magnitude of the
impact of repeated exposure to traumatic incidents, it is conservatively
estimated that over half of the population suffer from some form of
depression, anxiety, or post-traumatic stress as a result of these conditions
in Afghanistan.
‘At the same time, access to mental health care or psychosocial support
remains out of reach to many, particularly in rural areas. Despite Mental
Health and Psychosocial Support Services (MHPSS) being integrated into
the national Basic Package of Health Services (BPHS) and Essential
Package of Hospital Services (EPHS), nationwide only 320 hospital beds in
the public and private sector are available for people suffering from mental
health problems.’64
Back to Contents
4.5 Physical disabilities
4.5.1 In April 2020, HRW reported ‘Afghanistan has one of the largest populations
per capita of persons with disabilities in the world. At least one in five Afghan
households includes an adult or child with a serious physical, sensory,
intellectual, or psychosocial disability.’65 Citing the Asia Foundation’s Model
Disability Survey of Afghanistan 2019, the UNOCHA said in its December
2020 report, that ‘… 79 per cent of adults and 17 per cent of children are
estimated to live with some form of disability, while 8.9 per cent of the
population live with a severe disability.’66
63 HRW, ‘“Disability is not a weakness”’ (page 19), April 2020
64 UNOCHA, ‘Humanitarian Needs Overview 2021’ (page 33), December 2020
65 HRW, ‘“Disability is not a weakness”’ (page 1), April 2020
66 UNOCHA, ‘Humanitarian Needs Overview 2021’ (page 32), December 2020
Page 14 of 214.5.2 The April 2020 HRW report said in regard to rehabilitation for physical
disabilities:
‘Physical rehabilitation is not available in all provinces, and because patients
have to travel long distances to get services, many forego them altogether.
Traveling to obtain services has been, for many families, complicated by
poverty, poor quality roads, and danger along the way due to armed conflict.
Moreover, government health services lack trained personnel and technical
expertise to effectively deliver services to those with disabilities. A lack of
female health service providers means that women and girls with disabilities
have less access to services.’67
4.5.3 The UNOCHA December 2020 report noted the effect of COVID-19 on
services, stating:
‘… the country’s biggest disability therapy and prosthetics service run by the
International Committee of the Red Cross (ICRC) in Kabul, with satellite
hospitals in other parts of the country, was forced to scale-down its services
during COVID. In a normal year, the service treats approximately 3,300
patients, providing them with physical therapy, life-changing prosthetics and
opportunities to engage in sport. In 2020, the service scaled-down due to
social distancing requirements and reached only 1,810 clients. While the
service is now back up and running with COVID-safe measures in place, the
consequences of unmet needs for these services in 2020 will flow into
2021.’68
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4.6 Women’s health
4.6.1 In April 2020, HRW noted ‘Due to widespread gender segregation in Afghan
society, women and girls, in addition to likely preferring to receive care from
a female service provider, are likely to be barred by their families from
accessing care from male professionals.’69 However, the same report also
indicated a shortage of female health workers and trained professionals 70.
4.6.2 HRW reported in May 2021, ‘When the Taliban were in power pre-2001, they
imposed restrictions on the movement of women and girls that dramatically
curtailed their access to health care.’71 The report added that, as the Taliban
consolidated control across the country, ‘Taliban policies, such as allowing
women to travel only with a male relative or an older woman restricts
women’s access to health care in these areas, although female healthcare
workers provide services at clinics and hospitals, and make home visits to
see female patients.’72
4.6.3 The report also noted that, ‘At least some provision of health care for women
and girls should be able to continue regardless of whether the role of the
Taliban grows,’ as unlike the Taliban’s restrictions on access to education
67 HRW, ‘“Disability is not a weakness”’ (page 17), April 2020
68 UNOCHA, ‘Humanitarian Needs Overview 2021’ (page 38), December 2020
69 HRW, ‘“Disability is not a weakness”’ (page 17), April 2020
70 HRW, ‘“Disability is not a weakness”’ (page 17), April 2020
71 HRW, ‘“I Would Like Four Kids – If We Stay Alive” Women’s Access…’ (page 47), May 2021
72 HRW, ‘“I Would Like Four Kids – If We Stay Alive” Women’s Access…’ (page 47), May 2021
Page 15 of 21and employment for girls and women, during their previous rule, they did not
impose blanket restrictions on women’s access to healthcare73.
4.6.4 In April 2020, HRW noted that ‘Prenatal and maternal health care is
particularly poor throughout rural Afghanistan. Maternal deaths remain
among the highest in the world.’74
4.6.5 On 13 September 2021, the UN Population Fund (UNFPA) estimated that,
without immediate support for women and girls, there could be 51,000
additional maternal deaths, 4.8 million unintended pregnancies, and twice as
many people who won't be able to access family planning clinics between
now and 202575. Women also faced issues accessing health care as many
were unable to leave their homes without a mahram (male escort)76.
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73 HRW, ‘“I Would Like Four Kids – If We Stay Alive” Women’s Access…’ (page 48), May 2021
74 HRW, ‘“Disability is not a weakness”’ (page 19), April 2020
75 UNFPA, ‘As women and girls bear the brunt of the crisis, UNFPA urgently…’, 13 September 2021
76 BBC News, ‘Giving birth under the Taliban’, 20 September 2021
Page 16 of 21Terms of Reference
A ‘Terms of Reference’ (ToR) is a broad outline of what the CPIN seeks to cover.
They form the basis for the country information section. The Home Office’s Country
Policy and Information Team uses some standardised ToRs, depending on the
subject, and these are then adapted depending on the country concerned.
For this particular CPIN, the following topics were identified prior to drafting as
relevant and on which research was undertaken:
• Overview of the healthcare system
o Provision pre- and post-Taliban takeover
o Medical supplies
o Governance
• Access to medical treatment
o NGOs
o Cost
o COVID
o Mental health
o Disabilities
o Women’s health
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Page 17 of 21Bibliography
Sources cited
Afghanistan Analysts Network (AAN), ‘The Focus of the Taleban’s New Government:
Internal cohesion, external dominance’, 12 September 2021. Last accessed: 15
September 2021
Al Jazeera, ‘UN releases funds to save Afghan health system from collapse’, 22
September 2021. Last accessed: 24 September 2021
BBC News,
‘Afghanistan: World Bank halts aid after Taliban takeover’, 25 August 2021.
Last accessed: 17 September 2021
‘Giving birth under the Taliban’, 20 September 2021. Last accessed: 20
September 2021
‘“There’s security but no money”: Afghans settle into life under Taliban rule’,
18 September 2021. Last accessed: 20 September 2021
CIA, ‘The World Factbook: Afghanistan’, updated 8 September 2021. Last accessed
15 September 2021
European Asylum Support Office (EASO), ‘Afghanistan Key socio-economic
indicators: Focus on Kabul City, Mazar-e Sharif and Herat City’, August 2020. Last
accessed 14 September 2021
Gandhara, ‘Aid Groups In Afghanistan Face New Challenges Under The Taliban’, 16
September 2021. Last accessed: 17 September 2021
The Guardian, ‘Afghanistan’s shrinking horizons: “Women feel everything is
finished”’, 12 September 2021. Last accessed: 20 September 2021
Hashte Subh (8am) Daily, ‘The Taliban announce remaining cabinet members’, 21
September 2021. Last accessed: 27 September 2021
Human Rights Watch (HRW),
‘“Disability Is Not Weakness” Discrimination and Barriers Facing Women and
Girls with Disabilities in Afghanistan’, April 2020. Last accessed: 16
September 2021
‘“I Would Like Four Kids – If We Stay Alive” Women’s Access to Health Care
in Afghanistan’, May 2021. Last accessed: 16 September 2021
India Today, ‘Taliban ask women doctors, health workers to resume jobs in
Afghanistan’, 28 August 2021. Last accessed: 20 September 2021
International Federation of Red Cross and Red Crescent Societies (IFRC),
‘Emergency Appeal – Afghanistan Humanitarian Crisis’, 6 September 2021. Last
accessed: 16 September 2021
ITV News, ‘Afghanistan's women journalists, doctors and lawyers reveal reality of life
under Taliban’, 17 September 2021. Last accessed: 20 September 2021
The Lancet,
Page 18 of 21‘Access to health care under threat in Afghanistan’, 27 June 2020. Last
accessed: 16 September 2021
‘The World Bank's health funding in Afghanistan’, 3 September 2021. Last
accessed: 17 September 2021
Médecins Sans Frontières (MSF),
‘Afghanistan’, no date. Last accessed: 16 September 2021
‘Medical needs urgent as ever in Afghanistan after Taliban takeover’, 18
August 2021. Last accessed: 16 September 2021
The New Humanitarian, ‘Healthcare, aid, and the Taliban: A Q&A with Afghanistan’s
health minister’, 8 September 2021. Last accessed: 15 September 2021
The News International, ‘Afghanistan in desperate need of medicines’, 17 September
2021. Last accessed: 20 September 2021
New York Times (NYT), ‘After quick victory, Taliban find governing is harder’, 2
September 2021. Last accessed: 15 September 2021
Pajhwok News, ‘Some Ghor clinics stop functioning after WB halt fund’, 16
September 2021. Last accessed: 17 September 2021
Republic World, ‘Afghanistan: Taliban Sacks Last Remaining Minister From Ashraf
Ghani's Cabinet’, 22 September 2021. Last accessed: 27 September 2021
Reuters,
‘Afghanistan's healthcare system near collapse, aid agencies warn’, 30
August 2021. Last accessed 14 September 2021
‘Hundreds of health centres at risk of closure in Afghanistan’, 6 September
2021. Last accessed 14 September 2021
Shaheen, S (@SuhailShaheen1), Tweet ‘List of Acting Ministers and Heads of
Departments ( in English)’, 3.54am UK Time, 8 September 2021. Last accessed: 15
September 2021
South Asia Terrorism Portal, South Asia Intelligence Review (SAIR), ‘Weekly
Assessments & Briefings Volume 20, No.14’, 27 September 2021. Last accessed: 27
September 2021
Swedish Committee for Afghanistan (SCA), ‘SCA’s work continues in Afghanistan’,
updated 2 September 2021. Last accessed: 17 September 2021
Tolo News, ‘Low Quality Medicine Threatening Lives: Afghan Citizens’, 18
September 2021. Last accessed: 20 September 2021
UN Office for the Coordination of Humanitarian Affairs (UNOCHA), ‘Humanitarian
Needs Overview 2021’, December 2020. Last accessed: 16 September 2021
UN Population Fund (UNFPA), ‘As women and girls bear the brunt of the crisis,
UNFPA urgently seeks $29.2 million to save and protect lives in Afghanistan’, 13
September 2021. Last accessed: 20 September 2021
United States Institute of Peace (USIP), ‘Service Delivery in Taliban-Influenced
Areas of Afghanistan’, 30 April 2020. Last accessed: 14 September 2021
World Health Organization (WHO),
Page 19 of 21‘Funding pause results in imminent closure of more than 2000 health facilities
in Afghanistan’, 6 September 2021. Last accessed: 14 September 2021
‘Health Cluster Partners Operational Presence (August 2021)’, 20 September
2021. Last accessed: 20 September 2021
‘Qatar supports shipment of WHO life-saving medical supplies to Kabul’, 13
September 2021. Last accessed: 15 September 2021
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Sources consulted but not cited
Al Jazeera, ‘A month after Kabul’s fall, Taliban stares at humanitarian crisis’, 15
September 2021. Last accessed: 16 September 2021
NPR, ‘Afghanistan's Health Care Is In 'Limbo' Following Taliban Takeover, Says
MSF Rep’, 19 August 2021. Last accessed: 14 September 2021
UNICEF, ‘Country Office Annual Report 2020 – Afghanistan’, 2020. Last accessed:
20 September 2021
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Page 20 of 21Version control
Clearance
Below is information on when this note was cleared:
• version 2.0
• valid from 12 October 2021
Official – sensitive: Start of section
The information on this page has been removed as it is restricted for internal Home
Office use.
Official – sensitive: End of section
Changes from last version of this note
Updated country information following Taliban takeover in August 2021
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